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Specialized Pharmacology MN650 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Diabetes Definition:

A

body is unable to produce or use insulin

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2
Q

What are acute complications of DM?

A
  • Diabetic Ketoacidosis (DM type 1)

- Hyperglycemic Hyperosmolar Nonketotic Syndrome (DM type 2)

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3
Q

What are the chronic complications of DM?

A
  • neuropathy
  • nephropathy
  • retinopathy
  • gastroparesis
  • CVD
  • PVD
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4
Q

What are risk factors for DM type 1?

A
  • caucasion
  • family hx
  • genetic predisposition
  • african americans have lowest incidence of this type in the US
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5
Q

What is C-peptide and why do we test for levels?

A
  • a substance released from the pancreas along with insulin in equal amnts
  • used to differentiate DM type 1 and type 2
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6
Q

What will the C-peptide levels be in DM type 1?

A

absent (0) or low (< 0.5 ng/mL)

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7
Q

What acute complication(s) occur with DM I type?

A

diabetic ketoacidosis (DKA)

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8
Q

Definition of DM type 1?

A

pancreas produces little to no insulin

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9
Q

Islet cell antibodies and/or glutamic acid decarboxylase antibodies are found in which type of DM?

A

DM type 1

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10
Q

What is the most prevalent type of diabetes mellitus?

A

Type 2

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11
Q

what are chronic complications of diabetes mellitus?

A
  • neuropathy (Peripheral and autonomic)
  • nephropathy (May lead to end stage renal disease)
  • retinopathy
  • CVD
  • PVD
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12
Q

Notes: diabetes related retinopathy

  • occurs in approximately 15% of patients diagnosed with diabetes after 15 years
  • risk of occurrence increases by 1% each year after diagnosis
A

Notes: cardiovascular disease

  • Diabetes is a risk factor for atherosclerotic development
  • hypertension in diabetics type 2 is x2 greater than general population
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13
Q

Islet cell antibodies and/or glutamic acid decarboxylase antibodies are found in which type of DM?

A

DM1

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14
Q

What is the most prevalent type of diabetes mellitus?

A

DM type 2

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15
Q

At what age does type one diabetes usually occur?

A

< 20

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16
Q

At what age does type 2 diabetes usually occur?

A

> 45

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17
Q

Definition of diabetes type 2?

A

Insulin insensitivity, resistance and/or impaired production of insulin

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18
Q

What will the C peptide levels be in DM type 2?

A

normal or high

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19
Q

In which type of diabetes mellitus will autoimmune antibodies be present?

A

DM type 1

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20
Q

Metabolic syndrome is associated with which type of diabetes mellitus?

A

Type 2

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21
Q

Metabolic syndrome by?

A
  • Obesity: waist circumference
    • > 40 inches for men
    • ≥ 35 inches for women
  • Hypertension
  • abnormal HDL:
    • men: < 40 mg/dL
    • women: < 50 mg/dL
  • abnormal triglycerides: ≥ 150 mg/dL
  • fasting blood glucose: ≥ 100 mg/dL
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22
Q

Ketone productions are seen in which type of diabetes mellitus?

A

Type 1

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23
Q

What acute complication occurs with type 2 diabetes mellitus?

A

-Hyper glycemic hyperosmolar nonketotic syndrome

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24
Q

Types of diabetes mellitus?

A
  • type 1
  • type 2
  • gestational diabetes
  • secondary diabetes r/t other primary condition
  • pre-diabetes
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25
Q

Causes of secondary diabetes mellitus?

A
  • hormonal excess
  • medications
  • pancreatic disease
  • other genetic factors
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26
Q

Secondary diabetes mellitus occurs with which endocrine diseases?

A
  • Cushing syndrome
  • acromegaly
  • hyperthyroidism
  • pheochromocytoma
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27
Q

Which medications can cause secondary diabetes mellitus?

A
  • Glucocorticoids
  • diuretics
  • phenytoin (dilantin)
  • oral contraceptives
  • Statin
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28
Q

Which pancreatic diseases can cause secondary diabetes mellitus?

A
  • pancreatitis
  • pancreatectomy
  • cystic fibrosis
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29
Q

What genetic syndromes are associated with diabetes mellitus?

A
  • Down syndrome
  • Turner syndrome
  • klinefelter syndrome
  • wolfram syndrome
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30
Q

What does the acronym DIDMOAD stand for in Wolframs syndrome?

A
  • diabetes insipidus (DI)
  • diabetes mellitus (DM
  • optic atrophy (OA)
  • deafness (D)
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31
Q

What are the symptoms of type one diabetes?

A
  • Polyuria, polydipsia, polyphasia
  • rapid weight loss
  • weakness/fatigue
  • blurred vision
  • nocturnal enuresis
  • frequent infections
  • changes in LOC (irritability to coma)
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32
Q

What body type is seen in patients with type one diabetes?

A

Thin, loss of subq fat and muscle wasting

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33
Q

What are the symptoms of type 2 diabetes?

A
  • Maybe asymptomatic
  • polyurea, polydipsia
  • weight loss (yet patient is often overweight )
  • weakness/fatigue
  • frequent infections
  • peripheral neuropathy
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34
Q

What body type is seen in patients with type 2 diabetes?

A

Obese or history of obesity

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35
Q

What positive findings need to be present on different days for diagnosis of diabetes mellitus and/or impaired glucose homeostasis?

A
  • Symptoms of diabetes (polyurea, polydipsia, unexplained weight loss)
  • random blood glucose ≥ 200 mg/dL
  • Fasting blood glucose ≥ 126 md/dL on two separate occasions
  • 2 hour post oral glucose tolerance test with 75 gram glucose load ≥ 200 mg/dL
  • HbA1c ≥ 6.5%
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36
Q

What HbA1c value is indicative of prediabetes?

A

5.7 - 6.4%

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37
Q

Which lab should you check when testing for diabetes or on a diabetic patient?

A
  • blood glucose levels, HbA1c
  • urinalysis (to monitor for glycosuria or ketonuria)
  • BUN and creatinine (r/o dehydration)
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38
Q

Ketonuria will be present in which type of diabetes?

A

DM type 1

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39
Q

What is the normal HbA1c range?

A

5.5 - 6.4%

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40
Q

how often should HbA1c levels be checked in patients with uncontrolled glucose levels?

A

quarterly (q 3 months)

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41
Q

Once optimal glycemic control has been reached how often should HbA1c levels be checked?

A

every six months

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42
Q

Nutrition breakdown for patients living with diabetes:

A
  • total carbohydrates = 55-60% total caloric intake
    • fiber = 25 g/1000 calories
    • fats = 25-35% total calories
    • protein = 15-20% total calories
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43
Q

How often should diabetics eat (type 1 and 2)?

A
  • type 1: scheduled three meals each day and three snacks

- type 2: eat meals five hours apart with few or no snacks in between

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44
Q

Overuse of alcohol can cause what condition in diabetic patients?

A

Hypoglycemia

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45
Q

Exercise recommendations for diabetic patients?

A
  • Exercise > 30 min, with warm up and cool down.
  • ≥ 150 min mod-vigorous aerobic activity/wk
  • Monitor for dehydration, encourage fluid intake
  • inject insulin in body part not being exercised
  • eat additional carbs prior to exercise
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46
Q

Why is foot care important for the diabetic patient?

A

Because of increased risk of infection due to peripheral neuropathy (ex. loss of sensation)

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47
Q

Foot care infection prevention techniques for the diabetic patient?

A
  • Examine feet daily including bottoms of feet and in between the toes
  • report any changes in skin condition of feet immediately to the provider
  • have nails trimmed by experienced health care provider
  • wash feet daily with lukewarm water mild soap, Pat dry, apply lotion
  • use caution with footwear (might not know they are too tight)
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48
Q

What is the initial dose range of insulin for an type one diabetic?

A

0.4 -1.0 units /kg/day

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49
Q

How is the total daily dose of insulin administered for a type one diabetic?

A
  • 50% administered as basal dose QHS

- 50% administered as prandial dose

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50
Q

Lantus and Detemir are what types of insulin?

A

long acting insulin

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51
Q

Lispro, Aspart, Glulisine, Regular are what types of insulin?

A

Short acting insulin

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52
Q

Name the long acting insulin types?

A

Lantus and Detemir

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53
Q

Name the short acting insulin types?

A
  • Lispro
  • Aspart
  • Glulisine
  • Regular
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54
Q

What is the dosage for Lispro (Humalog)?

A

0.5 -1 unit/kg/day

55
Q

What is the dosage for Aspart (Novolog) insulin?

A

0.2 - 0.6 units/kg

56
Q

What is the dosage for Glulisine (Apidra) insulin?

A

0.5 – units/kg

57
Q

How and when is Glulisine administered?

A

Subq 15 minutes prior or 20 minutes after starting a meal

58
Q

What is the onset of action for regular insulin?

A

30-60 minutes

59
Q

What is the onset of action for lispro (Humalog)?

A

15-30 min

60
Q

what is the duration of lispro?

A

3-5 hrs

61
Q

what is the duration of regular insulin?

A

5-8 hrs

62
Q

What type of insulin is NPH?

A

Intermediate acting

63
Q

what are the types of NPH?

A

Humulin N and Novolin N

64
Q

What is the onset of action for NPH?

A

2-4 hrs

65
Q

What is the duration of NPH?

A

12-15 hrs

66
Q

What is the onset of action for Glargine (Lantus)?

A

1-2- hrs

67
Q

what is the duration of Glargine (Lantus)?

A

Up to 24 hrs

68
Q

Which types of insulins can be combined in the same syringe?

A

short and intermediate acting insulin

69
Q

What is the drug of choice for treating type 2 diabetes?

A

Metformin

70
Q

It is recommended to add a Glucagon-like peptide one receptor agonist to the treatment of which diabetic patient?

A

Diabetes type 2 with actual or high risk developing atherosclerotic CVD

71
Q

Type 2 diabetics with actual or high risk of of developing atherosclerotic CVD would benefit from the addition of which medicine to their treatment regimen? Glucagon like peptide one receptor agonist (GLP-1RA)

A

Glucagon like peptide one receptor agonist (GLP-1RA)

72
Q

Sodium glucose Co transporter two inhibitor is recommended for which diabetic patient?

A

type 2 diabetic with established kidney disease or heart failure

73
Q

Type 2 diabetics with established kidney disease or heart failure would benefit from the addition of which drug to their treatment regimen?

A

sodium glucose Co transporter 2 in`hibitor (SGLT2i)

74
Q

When should treatment of type 2 diabetes should be considered If what symptoms are present?

A
  • ongoing weight loss
  • symptoms of hyperglycemia
  • A1C > 10%
  • BG > 300 mg/dL
75
Q

What is the prandial or meal time dose of insulin for a type 2 diabetic?

A

4 units per day or 10% of basal insulin dose

76
Q

What patient in medication attributes need to be considered when developing a therapy for type 2 diabetics?

A
  • initial A1C
  • duration of diabetes (how long they’ve had it)
  • obesity status
  • risk of inducing hypoglycemia
  • risk of weight gain
  • risk reduction in heart, kidney, or liver disease
77
Q

The AACE/ACE guidelines recommend what type of therapy for an initial A1C < 7.5%?

A

monotherapy

78
Q

The AACE/ACE guidelines recommend what type of therapy for an initial A1C 7.5 ≤ 9.0%?

A

Dual therapy

79
Q

The AACE/ACE guidelines recommend Monotherapy for what entry A1C value?

A

< 7.5%

80
Q

The AACE/ACE guidelines recommend Dual therapy for what entry A1C value?

A

7.5 ≤ 9.0%

81
Q

When is insulin recommended for type 2 diabetics?

A

Pt on two oral antihyperglycemic agents and A1C > 8% and/or longstanding type 2 diabetes and less likely to reach third A1C goal with a third oral agent

82
Q

What is the initial insulin dosage for T2D?

A

0.2 - 0.3 unit/kg/day

83
Q

Note:
- basil insulin analogs are preferred over NPH insulin because a single basil analogue dose provides a flat serum insulin concentration for 24 hours or longer.

A

Note:
When transitioning off of an insulin drip reduced the calculated TDD by 80%, do to 20% of protein binding to IV bags and tubing. Then give 50% as basil dose and 50% as pre prandial dose.

84
Q

Sulfonylureas are indicated for the treatment of which type of diabetes?

A

type 2

85
Q

Sulfonylureas provide what duration of coverage?

A

12 - 24 hours

86
Q

Glipizide, Glyburide, Micronase, Glimepiride are what category of drugs?

A

Sulfonylureas

87
Q

Biguanides are recommended for the treatment of which type of diabetes?

A

type 2

88
Q

Metformin HCl is what category of drug?

A

Biguanide

89
Q

Alpha-glucosidase inhibitors are recommended for the treatment of which type of diabetes?

A

type 2

90
Q

Acarbose and Miglitol or what category of drug?

A

Alpha-glucosidase inhibitors

91
Q

Metformin HCL (glucophage) provides what duration of action?

A

6 to 12 hours

92
Q

Metformin extended release (glucophage XL) provides what duration of action?

A

24 hours

93
Q

What is the starting dose of metformin? 500, 800, or 1000 mg

A

500, 800, or 1000 mg

94
Q

What is the daily dosage for metformin HCl?

A

500 - 2550 mg 1-3/per

95
Q

What is the starting dose for metformin extended release?

A

500 mg

96
Q

What is the daily dosage for metformin extended release?

A

500 - 2000 mg QD with evening meal

97
Q

How is the Somogyi effect diagnosed?

A

At 3AM Hypoglycemic, then hyperglycemic at 7AM

98
Q

What is the treatment for Somogyi effect?

A
  • reduce or mid bedtime dose of insulin
  • administer long acting insulin in the AM
  • consider switching from lantus to levemir which is shorter acting
99
Q

What is the dawn phenomenon?

A

Decreased insulin sensitivity at night due to presence of growth hormone, Hypoglycemic at 7:00 AM

100
Q

What is the treatment for the dawn phenomenon?

A

add or increase the bedtime dose of insulin

101
Q

What are the ADA glucose level goals for the following nonpregnant, preprandial, and post prandial?

A
  • A1C < 7%
  • pre prandial glucose 80 - 130 mg/dL
  • postprandial glucose < 180 mg/dL
102
Q

When should insulin therapy be initiated in noncritical hospitalized patient?

A

Persistent BG ≥ 180 mg/dL

103
Q

When is a BG goal of < 200 appropriate?

A

in patients with terminal illness, limited life expectancy, or at high risk for hypoglycemia

104
Q

What action is taken for a non critical hospitalized patient previously on insulin therapy?

A

reuce outpatient insulin dose by 20 -25%

105
Q

How often should BG levels be checked in patients who are eating and NPO In an acute hospital setting ?

A
  • Eating: prior to meals

- NPO: q4-6hrs

106
Q

How do you calculate the total daily dose of insulin when transitioning off of an insulin drip?

A
  • (avg insulin gtt rate x past 6 hrs) x 24 hours = TDD
  • Reduce TDD by 20%
  • administer remaining 80%
    • 50% = basal and 50% preprandial
  • if NPO (no tube feeds) give entire dose as basal dose
107
Q

What are the signs and symptoms of hypoglycemia?

A

anxiety, behavioral changes, cognitive dysfunction, sweating, palpitations, hunger, paresthesia, tremors, seizures, and coma

108
Q

Symptoms of DKA include?

A

Polyurea, polydipsia, N/v, weight loss, vision changes, HA, Abdominal pain, bloating, Constipation, weakness and fatigue, altered LOC, flushed dry skin, kussmaul respirations, fruity breath, tachycardia, hyperkalemia, hypertension, temperature variation

109
Q

DKA patients without infection are hypothermic, normothermic, or hyperthermic?

A

Hypothermic

110
Q

DKA patients with infection are hypothermic, normothermic, or hyperthermic?

A

Normal or hyperthermic

111
Q

What is the Blood glucose levels in patient with DKA?

A

> 250

112
Q

ABG values (ph, pCO2, and HCO3) and interpretation for DKA patient?

A
  • PH usually < 7.3
  • pCO2 < 40
  • HCO2 < 15
  • Metabolic acidosis
113
Q

Why does hyperkalemia occur during DKA?

A

shifting of hydrogen ions enter cells to buffer acidosis

Hydrogen ions are exchanged for potassium ions

114
Q

What lab values will be hi in a patient with DKA?

A

ketone in urine, potassium, BUN, hematocrit, serum osmolality, anion gap, cholesterol, triglycerides, amylase

115
Q

what is the normal anion gap?

A

7 - 17 mEq/L

116
Q

Fluid management of the patient in DKA?

A

Fluid replacement with 0.9% NS at 1000 ml/hr (1-2hr or 15-20 ml/kg/hr)
250 ml/hr after improvement of dehydration
expect to order about 4-8 liters of fluid during the first 24 hours of treatment

117
Q

0.45% NaCl is what type of solution?

A

Hypotonic

118
Q

When is 0.45% NaCl solution used in the treatment of a DKA patient?

A

Once the patient is hemodynamically stable to promote intracellular hydration

119
Q

When and why is D5W/0.45% NaCl used in the treatment of a DKA patient?

A

When BG falls to 250 to prevent cerebral edema caused by lowering glucose too quickly

120
Q

Before starting insulin therapy , serum potassium should be at what level?

A

3.3 mEq/L

121
Q

When should long acting insulin and weaning of insulin infusion be considered in the treatment of a DKA patient?

A

When BG is 250 and the anion gap closed

122
Q

When is basal insulin administered when transitioning from IV insulin to subq?

A

2 - 4hrs prior to IV insulin being stopped

123
Q

Hyperosmolar hyper glycemic non ketosis occurs in which type of diabetic patient?

A

Type 2

124
Q

why does Hyperosmolar hyper glycemic nonketosis occur?

A

patient is able to produce enough insulin to prevent ketoacidosis, but not enough to prevent severe hyperglycemia , osmotic diuresis, and extracellular fluid depletion

125
Q

Why does hyperglycemia cast changes in LOC and neurologic signs and symptoms?

A

Increased osmolality causes intracellular and cerebral dehydration

126
Q

How are ketones produced?

A

Lack of insulin results in low glucose use prompting the use a fat (lipolysis) as an energy source. fat breakdown results in ketone production

127
Q

Acetone ( fruity) breath is noted in which type of patient and why?

A

DKA patient due to ketones

128
Q

signs and symptoms of hyperosmolar hyper glycemic non ketosis?

A

changes in LOC, lethargy, seizures, stupor, coma, signs of dehydration, polyurea, hypertension, tachycardia, shallow breathing

129
Q

Blood glucose levels impatient in hyperosmolar hyper glycemic non ketosis?

A

> 600

130
Q

Lab findings in patient with hyperosmolar hyper glycemic non ketosis?

A 
Blood glucose > 600
	elevated serum osmolarity 
	elevated BUN and creatinine 
	elevated sodium 
	pH > 7.3
	Normal anion gap 
	C peptides may be present (indicative of insulin production)
131
Q

Why are serum sodium levels high in a patient with HHNS?

A

kidneys try to conserve water by retaining Na

132
Q

What are complications too much fluid replacement?

A

cardiac failure, cerebral edema, seizures

133
Q

Which electrolytes are trended during HHNS treatment?

A

Na, K, HCO3, Cl, phosph

Specialized Pharmacology MN650 (28 decks)

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